Today, as the COVID-19 pandemic highlights the importance of access to quality health care, the Human Rights Campaign Foundation (HRC Foundation) released its 13th annual Healthcare Equality Index (HEI), which scores health care facilities on policies and practices dedicated to the equitable treatment and inclusion of their LGBTQ patients, visitors and employees. A record 765 health care facilities actively participated in this year’s survey, and, even as the Trump-Pence administration continues its assault on LGBTQ-inclusive health care, 495 of them earned a top score of 100. They received HRC’s coveted “Leader in LGBTQ Health Care Equality” designation.

Every year, HRC Foundation recognizes the health care facilities that participate in the HEI for their dedication and commitment to LGBTQ inclusion. HRC Foundation also extends its deepest gratitude to these facilities for their courageous fight against COVID-19 and their commitment to addressing racism and injustice. As the final HEI surveys were submitted in March, health care facilities were kicking into overdrive to meet the challenges of COVID-19. Many faced a lack of equipment, staffing shortages and surging demand. Two months later, as the fight against COVID-19 continued, the murders of George Floyd and Breonna Taylor by police officers thrust America’s structural racism into the spotlight. HEI participants issued strong statements on racial justice and equity, participated in White Coats for Black Lives demonstrations and announced new programs to address racial inequities in their institutions and their communities.

This year’s report also comes just after HRC Foundation and our co-counsel Baker Hostetler won a preliminary injunction against a Trump-Pence administration regulation, published through the Department of Health and Human Services, that would have eliminated explicit protections from discrimination based on sex stereotyping and gender identity, thereby sanctioning discrimination against LGBTQ people, particularly transgender people, in health care programs and activities. The rule was scheduled to take effect on August 18 but is now precluded from becoming operative.

In the 2020 report, an impressive 495 facilities earned HRC Foundation’s “LGBTQ Health Care Equality Leader” designation, receiving the maximum score in each section and earning an overall score of 100. Another 193 facilities earned the “Top Performer” designation for scoring from 80 to 95 points. With 90% of participating facilities scoring 80 points or more, health care facilities are demonstrating concretely that they are going beyond the basics when it comes to adopting policies and practices in LGBTQ care.

The remarkable progress reflected in the 2020 HEI includes:

• 92% of participants met the HEI's training requirements, completing more than 150,000 hours of staff training in LGBTQ patient-centered care.
• 99% of HEI participants documented that they include both “sexual orientation” and “gender identity” in their patient non-discrimination policy.
• 99% of HEI participants documented that they include both “sexual orientation” and “gender identity” in their employment nondiscrimination policy.
• 53% of HEI participants indicated that their facility has a policy or policies that specifically outline procedures and practices aimed at eliminating bias and insensitivity, and ensuring appropriate, welcoming interactions with transgender patients.
• After many years of trailing their corporate counterparts in the provision of transgender-inclusive health care benefits for employees, HEI participating healthcare facilities are nearly on par with the HRC Foundation’s Corporate Equality Index (CEI) participants as 80% have at least one health care plan that offered this benefit. The latest CEI noted 85% of participants having such benefits.

In addition to active survey participants, the HRC Foundation proactively researched the key policies at over 1,000 non-participating hospitals. Unfortunately, the adoption rate at these researched hospitals stands in stark contrast to the near-perfect adoption by active participants. Among the researched hospitals in which we were able to find or obtain enumerated patient non-discrimination policies, only 67% have policies that include both “sexual orientation” and “gender identity,” and only 63% were found to have an LGBTQ-inclusive employment non-discrimination policy. The equal visitation policy, at 93%, is the only one that comes close to matching the rate of the participating facilities.